Step 1 therapy for children 6 years and older
Prescribe as-required reliever therapy for all children aged 6 years and older with a diagnosis of asthma. Use a short-acting beta2 agonist (SABA)—either salbutamol (via a pressurised metered dose inhaler [pMDI]) or terbutaline (via dry powder inhaler [DPI]):
1 salbutamol 100 micrograms, 2 to 12 inhalations via pMDI with spacer, as required asthma, Step 1 therapy (child 6 years or older) salbutamol
OR
2 terbutaline 500 micrograms, 1 to 6 inhalations via DPI, as required1. asthma, Step 1 therapy (child 6 years or older) terbutaline
Counsel parents and carers to give reliever therapy when the child has wheeze associated with increased work of breathing; it is not usually necessary for isolated cough or mild wheeze without increased work of breathing.
Educate parents and carers about how to use the inhaler, including advice about using a spacer (recommended for all children using a pMDI) and a mask (if required for children using a pMDI). See Summary of inhalational drug delivery devices for links to instructional videos and patient handouts for devices.
For children aged 6 years and older with asthma, as-required SABA therapy is often sufficient to manage symptoms.
If symptoms do not show a clear response to SABA therapy, review inhaler technique and check equipment (inhaler, spacer, mask) for breakage or blockage. Poor response to correctly used SABA therapy could indicate that the diagnosis of asthma is incorrect—assess for possible alternative diagnoses (see Alternative diagnoses that can be confused with asthma).
Some children also require regular preventer therapy—see Step 2 therapy for indications.
There is some evidence to suggest adding a dose of low-dose inhaled corticosteroid (ICS) taken whenever a dose of SABA is required can lower the risk of asthma exacerbations compared to SABA alone. At the time of writing, this is not usual practice in children.